A retrospective study to assess clinical outcomes among patients receiving a novel sequential bilateral transcranial magnetic stimulation protocol for depression

The original FDA-approved transcranial magnetic stimulation (TMS) protocol for depression unilaterally targets the left dorsolateral prefrontal cortex (LDLPFC). While this approach is effective for the treatment of depression, response and remission rates have been sub-optimal for the standard 30–36 session course. Recent attempts to enhance efficacy have involved examination of adjunctive protocols, additional targets, improved targeting methods, and accelerated protocols. Additional protocols have focused on low-frequency (e.g.1 Hz) to the right dorsolateral prefrontal cortex (RDLPFC) in a sequential bilateral (SBL) approach. A few small studies have investigated an alternative SBL protocol, adding intermittent theta burst (iTBS) to the RDLPFC, particularly in patients with comorbid conditions like anxiety or posttraumatic stress disorder (PTSD). In this naturalistic retrospective study, clinical outcomes were evaluated in response to an SBL protocol consisting of 10 Hz to the LDLPFC, followed by iTBS to the RDLPFC (mean 33.1 sessions, SD =4.9) in a large adult population ( N = 600) with and without comorbidities. Primary outcomes were changes in scores on the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety-7 (GAD-7). Secondary outcomes were changes in the Quality of Life Scale (QOLS) in a subset of patients. Patients with moderate-severe depression (baseline PHQ-9 > 10), had a mean reduction of 9.5 points ( p 10, response and remission rates were 79.9 % and 51.5 %, respectively. Among all patients, a mean improvement in QOLS from baseline to 30th treatment of 15.4 points (25 % improvement; p < .001) was observed. Results, while purely observational, demonstrate favorable response and remission rates relative to previous reports for standard and alternative rTMS protocols for depression and anxious depression.